Simplisticko

Simplisticko

“Look, I know Cuba is actually a prison nation where nobody’s gotten a new car since Fredo betrayed Michael, but I’m just using this as an extreme example for ironic purposes.”
—Michael Moore on Sicko

Sicko opens today nationwide, and already Michael Moore is busy distancing himself from, well, Michael Moore. The filmmaker, who probes health-care policy in his latest documentary, has told interviewers that he doesn’t actually think that Cuba is a model for the United States or that Canadian health care is nirvana—though he makes both points in his film. Why would Moore need to clarify his position? Perhaps it’s because even he recognizes that Sicko’s arguments are indefensible.

Sicko is not a documentary; it’s a cartoon, without animation. In the real world, health-care policy involves a sixth of the national economy, hundreds of government programs, thousands of private insurance plans, and hundreds of thousands of health-care workers; it is extraordinarily complex. In Sicko, by contrast, there are no nuances, no exceptions, no grays. Americans are exploited; insurance companies are bad; politicians are impotent.

Perhaps most remarkably, Moore finds perfection in Canada, Britain, France, and, yes, Cuba. He gushes that everyone in Canada enjoys coverage, and yet costs are lower there. Could there possibly be a tradeoff for this? In Sicko, there doesn’t seem to be any. Moore visits an ER in London, Ontario, and asks people how long they’ve waited for care. No one has cooled his heels for longer than 45 minutes!

Sicko’s depiction of Canadian health care is a complete misrepresentation. I grew up in Canada, so stories immediately jump to my mind: the relative who almost died of an acute abdomen, first waiting hours to see a doctor in an ER, then sent to another hospital for an ultrasound, and finally shipped back again by ambulance for the needed surgery; a woman with cancer who broke her hip (because of metastasis) and had to wait a dozen hours in an ER before being sent home.

But never mind the anecdotes: a recent government survey found that only half of the patients in Ontario hospitals received treatment in a timely manner. Indeed, wait lists and shortages plague practically every aspect of Canadian health care. Responding to the dearth of doctors, one township in Nova Scotia holds an annual lottery whose winners get an appointment with the local GP. So dire is the situation that the Supreme Court of Canada recently ruled that “access to a wait list is not access to health care” and struck down Quebec laws banning private insurance, deeming them an infringement on basic human rights. When Moore was challenged on this, he told an interviewer: “Well, okay, let’s set up a system where we don’t have the Canadian wait.” Problem solved!

In fact, the story is similar in socialized health-care systems throughout the Western world: dirty hospitals, low standards, poor access to new drugs and tests. And, as I point out in an essay in the forthcoming City Journal, countries practicing socialized medicine like Canada, Britain, France, and Sweden are increasingly willing to embrace market solutions. Moore, conveniently, makes no mention of this.

Some critics will excuse such liberties, arguing that while Moore can be dramatic, his fundamental arguments are sound. Acknowledging that he’s not “buying all the sunshine Moore spouts about health care elsewhere,” Richard Roeper of the Chicago Sun-Times nevertheless writes that Sicko is Moore’s “most impressive and accomplished work yet.” Fox’s Roger Friedman declares it “brilliant and uplifting.” Even in Canada, people are willing to forgive Moore for his interpretation of facts. In “Moore Is Right,” Toronto Star columnist Thomas Walkom gushes about the film, even though he recognizes that the portrayal of Canadian ERs is a stretch: “To any Canadian who has ever been forced to go to emergency, this would seem unbelievable.”

Therein lies the basic problem with Moore’s work: it isn’t fundamentally sound. And it’s not simply that his consideration of public systems borders on propaganda. He misunderstands the debate itself. Moore sees two options: government-run health care (Canada, France, Cuba) or some type of managed-care system. His point is that the latter doesn’t work, and so he looks longingly across the 49th parallel.

The issue is more complicated. American health care is an accidental system. Private coverage—which most Americans have—evolved when employers, allowed to offer health insurance in pre-tax dollars, used it to get around the wage controls of the Second World War. Public coverage like Medicaid and Medicare, on the other hand, takes its inspiration from the Beveridge report in Britain, drafted in the early 1940s. William Beveridge believed in zero-dollar health care—that people ought to pay nothing at the point of use. Today’s American health care fuses these two systems, but both of them result in heavy expenses, since they give patients no incentive to spend carefully: for every dollar spent on health care in the United States, just 14 cents comes out of the individuals’ pockets.

Not surprisingly, policymakers have spent decades scrambling to control costs. In the United States, beginning in the 1970s, they looked to managed care: if people had no incentive to think twice before using the system, company bureaucrats would think for them. As an alternative to managed care, others—like former House Ways and Means Chairman Wilbur Mills, who oversaw the passage of legislation creating Medicare and Medicaid—considered an expansion of government programs, which have relied on wage and price controls to rein in costs. The basic thrust of health care reform, then, has been to seek bureaucrats—whether government or HMO—to make decisions for Americans. Moore condemns the HMO approach, but he glosses over the government’s shortcomings.

But a third option exists. Why not turn decisions over to individuals? Your employer doesn’t make decisions about where you live or what you eat. Why should he decide about your health care? Health savings accounts, passed as part of the Medicare Modernization Act of 2003, represent a first step away from the paternalism of government programs and HMOs. The experiment is in its infancy, but the fundamental idea—individual choice and competition—reflects the values of the other five-sixths of the economy. Moore ignores the subject. Perhaps he’s spent too much time in Cuba, and not enough time in America.

But I must grudgingly acknowledge that he has done well for himself. Whereas most documentaries are lucky to make it to an art-house showing, Sicko is opening in 250 theaters in the United States alone. Documentary makers typically struggle to make ends meet and hope for a review in a community newspaper; Moore is a multimillionaire who just did Oprah. And so, in his American-bashing leftism, Moore embodies that most American of qualities: successful entrepreneurship.

His recent comments suggest that he may have some hesitation about the product he’s selling. But then, do you think the inventor of the plastic pink flamingo really has one of those ugly ornaments on his front lawn?

David Gratzer, a physician, is a senior fellow at the Manhattan Institute and the author of The Cure: How Capitalism Can Save American Health Care. He is blogging on Moore’s documentary at freemarketcure.com.